Methods and apparatus for securing a line

ABSTRACT

Methods and apparatus for securing a medical or surgical line with respect to a patient are described. In particular, a fastener is described comprising an elongate braided tubular sleeve ( 110 ) for receiving the line therethrough, the sleeve having a first end for fixing adjacent to the patient, in use, and a second end for arranging, in use, proximal to medical equipment coupled to the line. The fastener also includes a first substantially rigid collar ( 112 ) coupled to the sleeve at the first end of the sleeve and a second substantially rigid collar ( 114 ) coupled to the sleeve at the second end of the sleeve. An enlarged flange ( 116 ) is provided, secured to the first collar ( 112 ) at the first end of the sleeve and an adhesive plaster ( 118 ) for securing the fastener with respect to a patient is provided, the adhesive plaster being secured to the enlarged flange ( 116 ).

This application is a national phase application under 35 U.S.C. §371 ofInternational Patent Application No. PCT/GB2009/051452 filed Oct. 28,2009 which claims priority to UK Patent Application No. GB 0819782.4filed Oct. 28, 2008. The entire text of each of the above-referenceddisclosures are specifically incorporated herein by reference withoutdisclaimer.

The present invention relates broadly to the field of fasteners and isparticularly concerned with medical or surgical fasteners that securelines, such as catheters, other types of medical tubing or wires withrespect to a patient.

By way of background, catheters are long, thin, flexible tubes ofplastics material that can be inserted into a blood vessel or other bodycavity for introducing or removing fluids; either liquids or gases. Theyare used by medical personnel as a matter of routine. In one medicalprocedure a line or catheter is secured with respect to a patient, forexample medical tubing may be secured to a patient's arm, and in anotherprocedure an endotracheal tube may be secured to ventilate a patient. Inboth cases, it is desirable that, once the line has been inserted, it issecurely maintained in position unless a medical practitioner wishes toadjust the positioning of the line.

The insertion of a catheter into a patient is an intricate procedure.Therefore, once a line is in an acceptable position, it is essentialthat the line is securely anchored to avoid any accidental displacement.The line may need to be in place for a period of weeks: the longer aline remains undisturbed in situ in accordance with planned treatment,the lower the risk of harm to the patient. Similarly, the insertion ofan endotracheal tube can be a time-consuming and difficult procedure.Again, it is essential that, once inserted, such tubes are securelyfastened in position to avoid potential problems and complications forthe patient.

The applicant's earlier application, published as WO-A1-99/10250describes an improved fastener for securing a line to a patientincluding a braided sleeve portion for gripping a line and means forattaching the sleeve with respect to a patient. This application waslargely directed to embodiments in which the sleeve is sutured to apatient or attached via a harness.

The present invention provides improved devices for securely maintaininga line in position with respect to a patient.

A first aspect provides a fastener for securing a medical or surgicalline with respect to a patient, the fastener comprising:

-   -   an elongate braided tubular sleeve for receiving the line        therethrough, the sleeve having a first end for fixing adjacent        to the patient, in use, and a second end for arranging, in use,        proximal to medical equipment coupled to the line;    -   a first substantially rigid collar coupled to the sleeve at the        first end of the sleeve;    -   a second substantially rigid collar coupled to the sleeve at the        second end of the sleeve;    -   an enlarged flange secured to the first collar at the first end        of the sleeve;    -   an adhesive plaster for securing the fastener with respect to a        patient, the adhesive plaster being secured to the enlarged        flange and the adhesive plaster having an area of at least 5        cm².

It has been appreciated that providing a fastener with a sleeve and anadhesive plaster enables rapid, reliable and secure fixing of a linewith respect to a patient. No suturing or complicated connection of thesleeve is required, therefore it can be fixed in place bynon-specialists, such as nurses, paramedics and first-aid practitioners.Also, it can be used in a wide range of settings, such as for thefixation of a drip in a non-medical setting, for example in a militarysituation, on the street, or at a sporting match.

It has been found that the claimed combination of an enlarged flangesecured to a collar at one end of the sleeve and an adhesive plasterhaving an area of at least 5 cm², wherein the flange is secured to theadhesive plaster, provides secure attachment of the line to the patient.The adhesive plaster should be large enough to provide an adhesive forceto the patient greater than forces that are applied to the line duringnormal movement of a patient or forces applied by the patient tuggingthe line. Providing an enlarged flange advantageously enables a secureconnection between the braided tubular sleeve and the adhesive material.

In a preferred embodiment, the longitudinal axis of the elongate braidedtubular sleeve is arranged parallel to the plane of the adhesiveplaster.

In an alternative embodiment, the longitudinal axis of the elongatebraided tubular sleeve is arranged perpendicular to the plane of theadhesive plaster. That is, the plane of the flange is parallel to theface of the collar to which it is attached. This arrangement is usefulwhere the line needs to be held perpendicular to the patient's skin. Forexample at the point at which a chest drain enters the patient.

In a second aspect, there is provided a fastener for securing a medicalor surgical line with respect to a patient, the fastener comprising:

-   -   an elongate braided tubular sleeve for receiving the line        therethrough, the sleeve having a first end for fixing adjacent        to the patient, in use, and a second end for arranging, in use,        proximal to medical equipment coupled to the line;    -   a first substantially rigid collar coupled to the sleeve at the        first end of the sleeve;    -   a second substantially rigid collar coupled to the sleeve at the        second end of the sleeve;    -   an enlarged flange secured to the first collar at the first end        of the sleeve;    -   an adhesive plaster for securing the fastener with respect to a        patient, the adhesive plaster being secured to the enlarged        flange;    -   wherein the longitudinal axis of the elongate braided tubular        sleeve is arranged parallel to the plane of the adhesive        plaster.

In this embodiment, the plane of the flange is perpendicular to the faceof the collar to which it is attached. This arrangement of the sleeveand plaster is particularly suitable for situations in which the lineneeds to be held parallel to a patient's skin, for example when anintravenous drip is inserted into a patient. Arranging the sleeve to beheld parallel to the adhesive plaster reduces the forces that actagainst the adhesive force of the plaster. For example, a tugging forceapplied to the line acts as a sheer force on the adhesive plaster ratherthan acting in a perpendicular direction, which would make the plastereasier to remove.

In a preferred embodiment, the adhesive plaster has an area of at least5 cm².

In a preferred embodiment of the first and second aspects, the enlargedflange is coupled to a first layer of adhesive plaster by a second layerof adhesive plaster, the second layer of adhesive plaster being arrangedover the enlarged flange. That is, the flange is sandwiched between twolayers of adhesive plaster, thus securely retaining the flange on thefirst layer of adhesive plaster. This embodiment also minimises thetypes of materials required to manufacture the fastener and simplifiesthe manufacturing process. Preferably, the second layer of adhesiveplaster is larger than the area of the flange by at least around 0.5 cmin each direction, preferably at least around lcm.

In one embodiment, the enlarged flange has an area of at least 1 cm². Ina further embodiment, the enlarged flange has an area of at least 2 cm².

In one embodiment, the adhesive plaster has an area of at least 10 cm².In a further embodiment, the adhesive plaster has an area of at least 20cm². The area of the plaster may depend on factors such as the intendeduse of the fastener, the size of the patient, the adherence of thesurface onto which the fastener is applied and the length of time thefastener is expected to be attached to the patient.

In a preferred embodiment, the enlarged flange and the first collar aremanufactured using a common material. The material may comprise aplastics material, such as polypropylene or polyamide. Such materialsare easy to mould or extrude to form into a suitable shape and can bemade sterile for medical purposes.

In one embodiment, the enlarged flange is coupled to the first collarusing at least one technique selected from: ultrasound welding;high-frequency welding; and heat-sealing.

In particular, ultrasound welding techniques have been found to beparticularly advantageous in providing secure attachment betweencomponents of the fastener, for example between the collar and theflange.

In an alternative embodiment, the flange is moulded integrally with thecollar. In this way, the flange and the collar may be moulded as asingle piece, providing a very secure attachment between the collar andthe flange. The piece may be moulded using any suitable mouldingtechnique, in particular the piece may be injection-moulded.

In a preferred embodiment, the adhesive plaster comprises a sterilemedical or surgical plaster. Once formed, the fastener may be providedin a sterile pack in which it is transported and handled up to the pointat which the pack is opened for use.

In one embodiment, the plaster comprises a pre-applied adhesive coating.The plaster will therefore also include backing paper or plastic, whichcan be removed from the plaster to reveal the adhesive coating before itis applied to the patient.

In an alternative embodiment, an adhesive coating is applied to theplaster prior to the plaster being secured to the patient, for example amedial practitioner may spray an adhesive coating onto the plaster orthe patient and then press the plaster onto the sprayed coating.

In a preferred embodiment, the braided tubular sleeve comprises aplurality of braided strands.

Preferably, each collar is sealed to each of the strands at an end ofthe braided tubular sleeve. Hence the collar may be sealed to thestrands of the sleeve to secure the strands and avoid any fraying of thebraiding of the sleeve. Preferably, the strands are sealed to the sleeveusing adhesive or a welding technique, in particular ultrasound welding.

The collars enable a user to manipulate the ends of the sleeve; inparticular if the collars are pushed towards each other, the sleeve isshortened and widened and the sleeve is able to slide along the line.The collars can also be used to maintain an open aperture at each end ofthe sleeve to enable easy insertion of the line into the sleeve.

In a preferred embodiment. the adhesive plaster comprises a pre-formedcut-out adjacent to the first end of the elongate braided tubularsleeve. That is, there is a cut-out in the plaster at the end of thesleeve where the line interfaces with the patient. The cut-out may be anaperture through which the line can pass, or may be a missing portion ofthe plaster. The cut-out enables access to the patient's skin at a pointthat would otherwise be covered by plaster. The cut-out may also enablethe point at which the line interfaces with the patient to be positionedcloser to the point at which the line exits the tubular sleeve at thefirst collar, thus providing a more secure connection between the linein the sleeve and the patient.

In a preferred embodiment, the lateral force required to separate theadhesive plaster from the patient, applied substantially parallel to thelongitudinal axis of the elongate braided tubular sleeve, is greaterthan 1N.

Further preferably, the lateral force required to separate the adhesiveplaster from the patient, applied substantially parallel to thelongitudinal axis of the elongate braided tubular sleeve, is greaterthan 5N.

In some embodiments, the lateral force required to separate the adhesiveplaster from the patient, applied substantially parallel to thelongitudinal axis of the elongate braided tubular sleeve, is greaterthan 10N.

In a further aspect, there is provided a method of manufacturing aplurality of fasteners for securing a medical or surgical line withrespect to a patient, the method comprising:

-   -   providing a supply of a braided tubular sleeve having a length        of at least one metre;    -   providing a braided tubular sleeve portion from the supply, the        portion substantially having a selected length of less than 15        cm;    -   providing a collar around each end of the braided tubular sleeve        portion; and    -   sealing each end of the braided tubular sleeve portion within        each respective collar to form a first fastener;    -   repeating said providing to form at least one further fastener.

Preferably, the method further comprises separating the braided tubularsleeve portion from the supply. The portion may be separated from thesupply before the collars are attached to the sleeve.

In an alternative embodiment, the braided tubular sleeve portion isseparated after sealing the braided tubular sleeve portion within thecollars. This may prevent fraying or unravelling of the sleeve beforethe collar is fixed in place.

In a preferred embodiment, the braided tubular sleeve portion comprisesa braid of a plurality of strands of material and sealing the braidedtubular sleeve portion within each collar comprises sealing each of thestrands of material to each collar.

Preferably, sealing the braided tubular sleeve portion within eachcollar comprises at least one of

-   ultrasound welding the braided tubular sleeve portion to the collar;-   high-frequency welding the braided tubular sleeve portion to the    collar; and-   heat-sealing the braided tubular sleeve portion to the collar.

In particular, ultrasound welding has been found to be a particularlyadvantageous technique for sealing the strands of the braided tubularsleeve portion to the collar. This technique has been found to providereliably a secure connection between each of the strands and the collar,which prevents unravelling of the braid and enables the collars to beused to compress the sleeve portion.

A medical or surgical apparatus comprising a sealed sterile packcontaining:

-   -   a tube for supplying a fluid to or removing a fluid from a        patient;    -   a connector positioned at each end of the tube; and    -   a braided tubular sleeve surrounding the tube and positioned        between the connectors, the braided tubular sleeve comprising a        substantially rigid collar at each end of the sleeve;    -   wherein pushing the collars towards each other along the        longitudinal axis of the sleeve shortens and widens the sleeve,        allowing the sleeve to slide along the tube;    -   wherein the sleeve is biased to an elongate position so that        releasing the collars causes the sleeve to lengthen and grip the        tube;    -   wherein the maximum diameter of each connector is greater than        the internal diameter of each of the collars so that the collars        do not fit over either connector and the braided tubular sleeve        is retained on the tube.

A method of forming a medical or surgical apparatus comprising:

-   -   providing a tube for supplying a fluid to or removing a fluid        from a patient;    -   sliding a braided tubular sleeve onto the tube, wherein the        braided tubular sleeve comprises a substantially rigid collar at        each end of the sleeve and wherein sliding comprises:    -   pushing the collars towards each other along the longitudinal        axis of the sleeve to shorten and widen the sleeve;    -   sliding the sleeve onto the outer surface of the tube;    -   releasing the collars to enable the sleeve to return to a biased        elongate position, causing the sleeve to grip the tube;    -   attaching a connector to each end of the tube, wherein the        maximum diameter of each connector is greater than the maximum        internal diameter of either collar so that the collars do not        fit over either connector and the braided tubular sleeve is        retained on the tube; and    -   sealing the apparatus within a sterile container.

Providing a pre-formed set, which may be termed a “giving set”,including a fastener already threaded onto a collar may provide aconvenient way of attaching a tube to a patient. Since the fastenercannot fit over the connectors at either end of the tube, the fasteneris securely attached to the tube and, via the fastener, the tube issecurely attached to the patient.

The fastener may be secured to the patient using sutures, and sutureloops may be provided in the fastener for this purpose. Alternatively,the fastener may be secured with respect to the patient using anadhesive plaster as described above.

Embodiments of the present method and apparatus will now be described inmore detail with reference to the accompanying drawings in which:

FIGS. 1 a and 1 b are schematic illustrations of a fastener according toone embodiment in plan view and a cross-sectional view respectively;

FIGS. 2 a and 2 b are schematic illustrations of a fastener according toa further embodiment in plan view and a cross-sectional viewrespectively;

FIG. 3 is a schematic illustration of a fastener according to a furtherembodiment;

FIGS. 4 a and 4 b are schematic illustrations of a fastener according toa further embodiment in plan view and a cross-sectional viewrespectively;

FIG. 5 is a flow chart representing a method of manufacture of afastener according to one embodiment;

FIG. 6 illustrates a fastener according to a further embodiment.

A fastener according to one embodiment includes a braided tubular sleevecomprising a plurality of strands of helically-wound and interwoven orintertwined filaments of polyamide or Nylon™. The wall of the sleeve maytherefore be described as being braided or plaited to form a foraminousor perforated mesh, grid, net or web. Thus the wall defines numeroussmall openings between the strands of the braid, which expand orcontract as the sleeve is shortened and lengthened.

A collar is provided at each end of the sleeve. Each collar is formedseparately from the sleeve and is then placed around one of the ends ofthe sleeve and fixed to the strands that form the sleeve. The collar isalso formed from a plastics material, in this embodiment, also frompolyamide.

As described in more detail below, the collar is fixed to the strands ofthe sleeve using an ultrasound welding technique.

It will be appreciated that, due to the braided construction of thesleeve, the length of the sleeve can be varied by the application of acompression or tension force along the longitudinal axis of the sleeve.It will further be appreciated that elongation causes the sleeve tonarrow, whereas shortening the sleeve makes it wider.

Shortening of the sleeve causes the filaments of the braid to bunchtogether and to lie at a large angle with respect to the longitudinalaxis of the sleeve. Therefore, when the sleeve is shortened, thediameter of the aperture formed by the sleeve is at a maximum. Incontrast, elongation of the sleeve causes the filaments of the braid tolie at a smaller angle with respect to the longitudinal axis of thesleeve. Hence, the diameter of the aperture formed by the sleeve is at aminimum.

The sleeve is biased to a slightly elongated position so that thediameter of the braided sleeve is slightly narrower than the diameter ofthe aperture at each end formed by the collars. Therefore, when a tubeor line having a similar size diameter to that of the aperture formed bya collar is inserted through the sleeve, the sleeve is biased to gripthe tube or line.

It will be appreciated that, once the initial grip of the sleeve aroundthe line is established, further attempts to move the line axially withrespect to the sleeve will cause further longitudinal expansion forcesto be applied to the sleeve, hence causing the sleeve to narrow furtherand grip the line more tightly. This gives rise to a locking effect.However, it is further noted that release of the line is possible simplyby longitudinally compressing the sleeve to cause the diameter of thesleeve to widen and release the line. This longitudinal compression maybe achieved by moving at least one of the collars towards the middle ofthe sleeve. Adjustments to the line may then be made by sliding the linewithin the sleeve and the line may then be gripped again by releasingthe sleeve and allowing the sleeve to return to its expandedconfiguration.

It will be clear to the skilled person that many variations in designand construction of the fastener may be provided and some of the designsthat have been found to be particularly advantageous are described inmore detail below.

In some embodiments, the braid may be manufactured from other types ofmaterial, in particular other types of plastic, such as polypropylene.Similarly, the collars may also be manufactured from other types ofplastic, such as polypropylene or they may be manufactured using a metalmaterial.

Plastics or metal materials are particularly suitable for components ofthe fastener, since they may readily be sterilised for medical orsurgical use and can easily be moulded and joined together. Further, itmay simply the manufacturing to have the braid and the collar formedfrom the same material.

In one embodiment, the collar may be formed, at least in part, using theplastic of the sleeve. For example, the plastic strands of the sleevemay be heat-sealed or ultrasound welded together over a short distanceat the end of the sleeve to form a solid collar at each end of thesleeve. In this case, a separate collar may not be necessary.

In alternative embodiments, the collar may be fixed to the end of thesleeve using an alternative technique or a combination of techniques,such as heat-sealing, high-frequency welding, adhesive or by physicallytrapping the strands of the sleeve between two concentric layers of thecollar.

A specific embodiment of a fastener will now be described in more detailwith reference to FIGS. 1 a, 1 b, 2 a and 2 b.

The fastener of FIG. 1 a includes a braided tubular sleeve 110, having acollar at each end 112, 114. At one end of the sleeve 110, one of thecollars 112 is secured to a flange 116. As illustrated in FIG. 1 b, thecollar 112 is secured to the flange 116 via an arm portion 122. The armportion 122 lifts the collar 112 away from the surface of the flange116, enabling the flange 116 to be secured more easily to the attachmentmeans, as described below.

In this embodiment, the collar 112, the arm 122 and the flange 116 aremoulded in one piece. Therefore, the collar 112 is very securelyattached to the flange 116.

At each end, the braided sleeve 110 passes inside a collar 112, 114. Thestrands that make up the sleeve 110 are secured to each of the collars112, 114 using ultrasound welding. Therefore, each strand of the sleeve110 is securely attached to each collar 112, 114, preventing any frayingor unravelling of the sleeve.

To attach the fastener to a patient, the flange is secured to a plaster118. The back of the plaster 118 comprises an adhesive material withsufficient adhesion to secure the plaster to a patient's skin. Theplaster 118 is provided with backing paper or plastic, which is removedby a medical practitioner when the fastener is in position and thepractitioner wishes to secure the fastener to the patient.

The flange 116 is secured to the plaster using a second layer of plaster120, which is placed over the top of the flange 116 and onto the firstplaster layer 118, as illustrated in FIG. 1 b. The second layer ofplaster 120 extends over the edges of the flange 116 by about 1 cm ineach direction to ensure a secure connection of the flange 116 to thefirst layer of plaster 118.

The first layer of plaster 118 includes a cut-out section 124 whichenables a line emerging from the sleeve 110 to have direct access to thepatient's skin. The cut-out 124 may take many shapes and forms, forexample it may be a hole through which the line can pass. Alternatively,the collar 112 and flange 116 may be arranged at the edge of the plaster118 so that the line has access to the patient directly without the needfor a cut-out section.

In some embodiments, the collar 112 is secured to the arm 122 and thearm 122 is secured to the flange 116 using ultrasound welding techniqueas described below. The collar 112, the arm 122 and the flange 116 areall formed from the same material, in this embodiment polyamide.

In alternative embodiment, the arm 122 may be omitted and the collar 112may be secured directly to the flange 116. In this embodiment, thesecond adhesive material 120 may still be fitted around the collar 112and over the flange 116, but it may be more difficult to secure thematerial 120 to the flange 116 around the collar 112.

As an alternative to the use of the second layer of plaster 120, theflange 116 may be connected to the first plaster layer 118 using weldingor heat sealing techniques or another fixing mechanism, such as smallrivets, which may also be made from plastic.

An alternative embodiment of the fastener secured by a plaster isillustrated in FIGS. 2 a and 2 b. This embodiment also includes thebraided tubular sleeve 210 with collars 212, 214, one of which issecured or integrally moulded with a flange 216. The flange 216 issecured to a first layer of adhesive plaster 218 by a second layer ofadhesive plaster 220 that is placed over the flange 216. However, incontrast to the embodiment shown in FIGS. 1 a and 1 b, the sleeve ofFIGS. 2 a and 2 b is held perpendicular to the plaster 218, that isperpendicular to the skin of a patient to which the plaster is secured.

Further embodiments of the fastener are illustrated in FIGS. 3, 4 a and4 b. In the embodiment of FIG. 3, the sleeve 310 is attached to a strap312, which includes a hoop-and-loop portion at each end 314 to enablethe strap 312 to be secured at a selected width, for example around apatient's wrist. In order to secure the sleeve 310 to the strap 312, aflange 316 is supplied, which is securely attached to the collar of thesleeve 310. The flange 316 is secured to the strap 312 using an adhesiveplaster as described above (not shown) or for example by ultrasound orheat welding the flange to the strap or by other fixing means.

The embodiment illustrated in FIGS. 4 a and 4 b includes a flange 416secured around the sleeve 410 behind one of the collars 412, 414. Theflange of FIGS. 4 a and 4 b is preferably secured to the collar usingultrasound welding. As illustrated in FIG. 4 b, the flange includes atleast one preformed aperture, preferably two, which may be used tosecure the fastener to a patient, for example by suturing the fastenerto the patient, the sutures being passed through the apertures in theflange 416.

A method of manufacturing a plurality of fasteners according to oneembodiment is illustrated schematically in the flow chart of FIG. 5.

The method includes providing a supply of braided tubular sleeve 510,for example as part of a roll or cylinder. The supply includes a lengthof sleeve at least 1 metre in length, but is likely to be much longerthan this, preferably of the order of 100 s of metres, when a new supplyis brought into the manufacturing process.

A portion of braided tubular sleeve is provided from the supply 512. Thelength of the portion will depend on the length of the final fastener itis desired to create, however it is unlikely to be longer than 15 cm,more likely less than 10 cm, preferably around 5 cm or less. The lengthof the portion is related to the thickness of the sleeve; wider sleeveswill tend to be made into longer fasteners to provide sufficient grip onwider lines. The length of the portion is also related to the intendeduse of the fastener since some medical uses, for example where thepatient is expected to be moved a lot (e.g. use in a military situationor by paramedics) can be expected to put more strain on the fastenerthan others, for example neonatal care.

The method then includes providing a collar around the sleeve at leastone end of the portion 514 and the braided tubular sleeve is sealedwithin the collar 516.

The process then determines whether there is a further length of tubularsleeve on the supply 518. If so, the process continues by forming afurther fastener in the same way as just described for the firstfastener.

The collar is ultrasound-welded to the braided sleeve to ensure a securefixation between the collar and the sleeve. An insert may be providedwithin the sleeve to compress the ends of the braid against the innerwalls of the collar and hold the sleeve in position while the weldingtakes place. The collar and at least the portion of the sleeve lyingwithin the collar are directed within ultrasound welding apparatus andwaves at ultra-sonic frequencies are applied to the collar and sleeve.The waves are targeted to fall on, or to be focused on, the collar andthe portion of the sleeve within the collar. This is to prevent anyundesirable ultrasound welding of the sleeve outside the collar. Inparticular, the apparatus is arranged to prevent strands of the braidedsleeve from being welded to each other, which would prevent necessarycompression and extension of the sleeve.

A further collar is then secured to the other end of the sleeve to formthe fastener. The further collar may be threaded onto the sleevetogether with the first collar and both collars may be welded to thesleeve as part of the same process. Alternatively, the first collar maybe welded, the portion of sleeve cut, and the second collar then weldedto the other end of the portion of sleeve.

Once the fastener has been created in the manner described above, it maybe secured to attachment means, such as adhesive material, to formfasteners such as those described herein.

In particular, in one embodiment, one of the collars includes anenlarged flange section. This is placed onto an adhesive plaster andpositioned near to the edge of the plaster or close to a cut-outsection. A second piece of adhesive plaster, which is larger than theflange, is then placed over the flange and secured onto the first pieceof plaster, holding the flange in place on the first adhesive plaster.

For additional security, the flange itself may also have an adhesivesubstance applied to one or both of its surfaces. For example anadhesive substance may be sprayed onto the lower surface of the flangebefore it is placed onto the first adhesive plaster. This may besufficient to hold the flange onto the plaster however, for security, itis preferable for the second adhesive plaster to be provided over theflange.

In some embodiments, different fixing means may be provided as analternative or in addition, to secure the flange to the plaster.Depending on the materials from which the flange and plaster are made,the flange and plaster may be ultrasound welded or heat sealed together.Further, fixing means such as rivets, which may also plastic, may beprovided to hold the flange onto the adhesive plaster.

A further embodiment of a fastener is illustrated in FIG. 6, which is aschematic illustration of a giving set, as part of which a fastener maybe provided. The giving set includes a tube 612 for supplying fluid, forexample saline solution, to a patient. As part of the manufacturingprocess, a braided tubular sleeve 610 is passed onto the sleeve bycompressing the sleeve longitudinally, to widen the braid of the sleeveand sliding the sleeve 610 onto the tube 612.

Connectors (illustrated schematically in FIG. 6) 614, 616 are thenattached to each end of the tube 612. It is noted that the connectors614, 616 are larger than the collars provided at each end of the sleeve610 and are therefore larger than the maximum diameter to which thesleeve 610 can widen. Therefore, the sleeve cannot pass over theconnectors 614, 616 and cannot be removed from the tube 612 once theconnectors have been added to each end.

Therefore, it is advantageous to add the sleeve to the giving set duringthe manufacturing and assembly process. The whole assembly can then beprovided in a sterilised pack to medical practitioners. The sleeve thenprovides a convenient means by which the giving set can be attached withrespect to a patient.

It will be clear to the skilled person that the method and apparatusdescribed above are non-limiting embodiments and variations may beprovided within the scope of the claims, which now follow.

The invention claimed is:
 1. A fastener for securing a medical orsurgical line with respect to a patient, the fastener comprising: anelongate braided tubular sleeve for receiving the line therethrough, thesleeve having a first end for fixing adjacent to the patient, in use,and a second end for arranging, in use, proximal to medical equipmentcoupled to the line; a first substantially rigid collar coupled to thesleeve at the first end of the sleeve; a second substantially rigidcollar coupled to the sleeve at the second end of the sleeve; anenlarged flange secured to the first collar at the first end of thesleeve; an adhesive plaster for securing the enlarged flange withrespect to a patient, the adhesive plaster being secured to the enlargedflange, the adhesive plaster having a planar configuration defined bytransverse dimensions of the adhesive plaster that exceed a maximumthickness of the adhesive plaster; wherein the longitudinal axis of theelongate braided tubular sleeve is arranged parallel to the plane of theadhesive plaster.
 2. A fastener according to claim 1 wherein theadhesive plaster has an area of at least 5 cm².
 3. A fastener accordingto claim 1 wherein the enlarged flange is coupled to a first layer ofadhesive plaster by a second layer of adhesive plaster, the second layerof adhesive plaster being arranged over the enlarged flange.
 4. Afastener according to claim 1 wherein the enlarged flange has an area ofat least 1 cm² or at least 2 cm².
 5. A fastener according to claim 1wherein the adhesive plaster has an area of at least 10 cm² or at least20 cm².
 6. A fastener according to claim 1 wherein the enlarged flangeand the first collar are manufactured using a common material.
 7. Afastener according to claim 6 wherein the material comprisespolypropylene or polyamide.
 8. A fastener according to claim 1 whereinthe enlarged flange is moulded integrally with the first substantiallyrigid collar.
 9. A fastener according to claim 1 wherein the adhesiveplaster comprises a sterile medical or surgical plaster.
 10. A fasteneraccording to claim 1 wherein the plaster comprises a pre-appliedadhesive coating.
 11. A fastener according to claim 1 wherein anadhesive coating is applied to the plaster prior to the plaster beingsecured to the patient.
 12. A fastener according to claim 1 wherein thebraided tubular sleeve comprises a plurality of braided strands.
 13. Afastener according to claim 1 wherein the adhesive plaster comprises apre-formed cut-out adjacent to the first end of the elongate braidedtubular sleeve.
 14. A fastener according to claim 1 wherein the lateralforce required to separate the adhesive plaster from the patient,applied substantially parallel to the longitudinal axis of the elongatebraided tubular sleeve, is greater than 1N, is greater than 5N, or isgreater than 10N.